The Heel‑Pain Dilemma

Plantar fasciitis (PF) is the leading cause of heel pain, sidelining roughly 2 million Americans each year. When rest, ice and stretching fail, patients often ask our Phoenix clinic: “Should I try shockwave or stick with massage?” Let’s unpack the science so you can choose confidently.

Option 1: Extracorporeal Shockwave Therapy (ESWT)

How It Works

A handheld device delivers focused or radial acoustic pulses into the plantar fascia, triggering micro‑trauma that stimulates new blood flow and collagen remodeling.

Evidence at a Glance

🔍 Big Picture: What 9 Clinical Trials Showed

A meta‑analysis looked at 9 randomized controlled trials involving 935 people with chronic plantar fasciitis.

The result?
People who got ESWT were more than twice as likely to improve compared to those who received a placebo.

• Odds Ratio (OR): 2.58
  📖 Published in PMC

This is a strong signal that ESWT can make a real difference when other treatments haven’t helped.

🧪 Real-World Trial: Recalcitrant Cases

In another study, 245 patients with tough-to-treat (a.k.a. “recalcitrant”) plantar fasciitis were followed for 12 weeks—and some even up to a year.

What happened?

• Those who received ESWT saw significant reductions in pain
• Better function compared to the sham group
• Bonus: The benefits lasted long-term

📖 Published on PubMed

🇩🇪 Lessons From an Early German Study

An earlier multicenter German trial (with 256 patients) didn’t show much difference:

• 34% improvement with ESWT vs. 30% with placebo

Why?
This trial helped researchers realize that how the treatment is done really matters. Later studies adjusted the treatment protocols—and that’s when results started getting much better.

📖 Published on PubMed

💬 Final Takeaway

ESWT isn’t a magic bullet, but when used with the right technique and for the right patients, it can be a game-changer—especially for chronic cases that haven’t responded to other treatments.

‍

Typical plan: 3 sessions, once a week; each session lasts ≈ 15 minutes.

Pros

• Strong evidence for chronic (> 6 months) or “failed‑everything” cases
  
  
• Very low complication rate (temporary redness, tingling)
  
  
• Minimal down‑time — walk out of clinic
  
  

Cons

• Higher upfront cost than massage
  
  
• Mild soreness 24–48 h post‑session
  
  
• Not ideal for acute inflammatory phase (< 4 weeks)
  
  

Option 2: Sports / Medical Massage & Myofascial Release

Techniques Used

• Cross‑friction massage on the plantar fascia
  
  
• Myofascial release (MFR) to calf and foot arches
  
  
• Trigger‑point therapy to proximal calf, Achilles and intrinsic foot muscles
  
  

Evidence at a Glance

Study Design

Sample

Result

5‑week massage + trigger‑point program (case series) PMC

20 PF patients

Pain & functional scores fell steadily across 5 weeks.

RCT: MFR vs. standard stretching (n = 64) PubMed

12‑week follow‑up

MFR group showed 60 % pain reduction vs. 7 % in controls.

Manual therapy protocol comparison (manipulation vs. cross‑friction) PMC

42 PF patients

All groups improved; combo of manipulation + massage quickest to full pain‑free walking.

Typical plan: 6–8 weekly sessions, 30 minutes each, paired with daily home stretching.

Pros

• Lower cost per visit
  
  
• Immediate tissue pliability and circulation boost
  
  
• Excellent for tight calves or early‑stage PF
  
  

Cons

• Evidence base smaller and more heterogeneous than ESWT
  
  
• Results rely heavily on therapist skill and patient compliance
  
  
• Soreness/bruising possible if pressure too deep
  
  

Head‑to‑Head Comparison

Factor

Shockwave Therapy

Massage / MFR

Ideal Stage

Chronic (> 3 months) or recalcitrant PF

Acute to sub‑acute (< 3 months) or adjunct to other care

Sessions Needed

3–4

6–10

Avg. Pain Reduction

60–80 % by 12 weeks (best protocols)

40–60 % by 4–8 weeks

Cost (Phoenix range)

$250–$350 per session

$60–$110 per session

Insurance Coverage

Growing (MedPay, some PPOs)

Often covered as chiropractic soft‑tissue code

Side‑Effects

Mild ache, rare bruising

Temporary soreness, rare skin irritation

Evidence Quality

Multiple RCTs & meta‑analyses

Fewer RCTs, small sample sizes

When to Combine Both

Clinical experience and emerging studies suggest a hybrid approach works best for many athletes and busy professionals:

1. Start with 2–3 sessions of massage/MFR to release calf and arch tightness.
   
   
2. Add ESWT if pain plateau persists after 4 weeks or if ultrasound shows fascial thickening > 4 mm.
   
   
3. Integrate home calf stretches, toe curls, and night splints to maintain gains.
   
   

Safety & Contraindications

• ESWT: avoid in pregnancy, severe peripheral neuropathy, open heel wounds, or on anticoagulation without MD clearance.
  
  
• Massage: skip deep pressure if you have acute inflammatory arthritis, DVT, or skin infections.
  
  

Patient Success Snapshot

“I’d been limping for eight months. Two shockwave sessions at Hansen Chiropractic plus weekly calf release cut my morning pain from 8/10 to 2/10. I’m running again after six weeks.” — Marcus, 38‑year‑old marathoner

FAQ

How fast will I feel relief with ESWT?
Many feel a notable drop in first‑step pain by week 3; full collagen remodeling takes 6–8 weeks.

Does deep‑tissue massage risk further tearing the fascia?
When applied by a trained therapist within pain tolerance, massage stimulates fibroblast healing, not tearing.

Can I keep jogging during treatment?
Light jogging is okay if pain stays under 3/10; avoid hill sprints until cleared.

Key Takeaways

• ESWT boasts stronger high‑quality evidence for tough, chronic plantar fasciitis but costs more per visit.
  
  
• Massage and myofascial release are affordable first‑line options that also prep tissues for better shockwave results.
  
  
• A combined program plus targeted stretching provides the fastest, most durable pain relief.
  
  

Ready to End Heel Pain?

Hansen Chiropractic offers both radial shockwave therapy and sports massage under one roof in South Mountain, Phoenix. Call (602) 555‑1234 or book online for a personalized plantar‑fasciitis assessment.